Katrina Mark

Knowledge, Attitudes, and Practice of Electronic Cigarette Use Among Pregnant Women.

Objective:Electronic cigarettes (e-cigarettes) are a relatively recent phenomenon, serving dual roles as an alternative vehicle for nicotine delivery and a smoking-cessation tool. The purpose of this study was to determine pregnant womens knowledge, attitudes, and practice regarding electronic cigarettes. Study Design:A voluntary, anonymous survey was distributed to a convenience sample of pregnant women presenting to a university-based outpatient clinic. After survey completion, participants received information about smoking cessation and e-cigarettes. Data were examined using &khgr;2 and Fisher exact tests and analysis of variance. Stata was used for the analysis. Results:Of the 326 surveys distributed, 316 were completed (97%). Of the 316 participants, 42 (13%) reported having ever used e-cigarettes. Only 2 (0.6%) reported current daily use. Ever users were slightly older (27.3 years vs 25.4 years; P = 0.007) and more likely to be current smokers (43% vs. 14%; P < 0.001) compared with women who had never used electronic cigarettes. Knowledge of the harms of smoking was similar between the 2 groups. Overall, 57% of all respondents believed that e-cigarettes contain nicotine, 61% that e-cigarettes can be addictive, and 43% that e-cigarettes are less harmful to a fetus than traditional cigarettes. Among ever users, the most common reasons given for the use of e-cigarettes were the perception of less harm than traditional cigarettes (74%) and help with smoking cessation (72%). Conclusions:Misconceptions about e-cigarettes are common among pregnant women, potentially motivating use that may pose risks to both maternal and child health. Screening and education regarding e-cigarettes should be included in prenatal care. Future research in this area is necessary, including research examining pregnancy outcomes among women who use e-cigarettes.

Incisional Negative Pressure Therapy to Prevent Wound Complications Following Cesarean Section in Morbidly Obese Women A Pilot Study

Objective. We sought to evaluate the efficacy of incisional negative pressure therapy in decreasing postoperative wound complications when placed prophylactically over clean, closed incisions following cesarean section in obese patients. Study design. This was a retrospective cohort study comparing rates of wound complications following cesarean sections in morbidly obese women prior to and following the institution of standard use of prophylactic incisional negative pressure therapy. All women with a body mass index greater than 45 kg/m2 undergoing cesarean section in a 2-year period in a single institution were included. The exposure was incisional negative pressure therapy, which began in September 2009, versus standard wound dressing used in the previous year. The main outcome was wound complication identified by ICD-9 codes. Demographic and wound outcomes were compared with χ2 and t tests. Stata version 11.0 was used for all analysis. Results. A total of 63 women met the inclusion criteria, 21 of whom received negative pressure wound therapy. The historical comparison and exposure groups were similar in all characteristics studied with the exceptions of length of surgery (64 vs 76 minutes, P = .03), length of labor (78 vs 261 minutes, P = .02), scheduled versus nonscheduled (77% vs 52%, P = .04), and mean age (29.5 vs 26.1 years, P = .04), respectively. There were 5 wound complications in the control group (10.4%) and none (0%) in the study group (P = .15). Conclusions. This pilot study suggests a decrease in wound complications in morbidly obese women receiving incisional negative pressure therapy following cesarean section.

Cannabis and pregnancy: Maternal child health implications during a period of drug policy liberalization

Cannabis use is common and increasing among women in the United States. State policies are changing with a movement towards decriminalization and legalization. We explore the implications of cannabis liberalization for maternal and child health. Most women who use cannabis quit or cut back during pregnancy. Although women are concerned about the possible health effects of cannabis, providers do a poor job of counseling. There is a theoretical potential for cannabis to interfere with neurodevelopment, however human data have not identified any long-term or long lasting meaningful differences between children exposed in utero to cannabis and those not. Scientifically accurate dissemination of cannabis outcomes data is necessary. Risks should be neither overstated nor minimized, and the legal status of a substance should not be equated with safety. Decreasing or stopping use of all recreational drugs should be encouraged during pregnancy. Providers must recognize that even in environments where cannabis is legal, pregnant women may end up involved with Child Protective Services. In states where substance use is considered child abuse this may be especially catastrophic. Above all, care for pregnant women who use cannabis should be non-punitive and grounded in respect for patient autonomy.

Pregnant Womenʼs Current and Intended Cannabis Use in Relation to Their Views Toward Legalization and Knowledge of Potential Harm

Objectives: The objective of this study was to investigate pregnant womens current use of cannabis and their intended patterns of use with relation to their views on the legalization of cannabis and their knowledge of potential harms. Methods: A voluntary, anonymous survey regarding patterns of use of cannabis and views on legalization was distributed to a convenience sample of pregnant women presenting for prenatal care at an outpatient university clinic. Chi-square and Fischers exact tests were used for analysis using STATA. Results: Of 306 surveys returned, 35% of women reported currently using cannabis at the time of diagnosis of pregnancy and 34% of those women continued to use. Seventy percent of respondents endorsed the belief that cannabis could be harmful to a pregnancy. Fifty-nine percent of respondents believed that cannabis should be legalized in some form and 10% reported that they would use cannabis more during pregnancy if it were legalized. Those who continued to use cannabis during pregnancy were less likely than those who quit to believe that cannabis use could be harmful during pregnancy (26% vs 75%, P < 0.001). The most common motivation for quitting cannabis use in pregnancy was to avoid being a bad example (74%); in comparison, only 27% of respondents listed a doctors recommendation as a motivation to quit. Conclusions: Cannabis use during pregnancy is relatively common and persistent, despite knowledge of the potential risks of harm. Views toward legalization vary among pregnant women and may impact cannabis use during pregnancy. In a changing legal climate, there is a need for clear messaging on the effects of cannabis use during pregnancy.

Marijuana use and pregnancy: prevalence, associated behaviors, and birth outcomes.

INTRODUCTION: This study examines the prevalence, behaviors, and birth outcomes associated with marijuana use in pregnancy. METHODS: This was a retrospective cohort study of patients presenting for prenatal care in a university-based setting from July 1, 2009, to June 30, 2010. The primary exposure was marijuana use, defined by self-report or first-trimester urine toxicology. Continued use was evaluated by urine toxicology each trimester and at the time of delivery. Demographic and outcome data were determined by chart review and analyzed by &khgr;2, Fishers exact, analysis of variance, and logistic regression. RESULTS: Three hundred ninety-six patients initiated prenatal care during this timeframe, 79 (20%) of whom tested positive for marijuana. Patients who smoked marijuana were less likely to have graduated high school (P=.016) or be employed (P=.015) but were more likely to use tobacco (P<.001) or alcohol (P=.032) and report a history of abuse (P=.01) or depressed mood (P=.023). When analyzed by logistic regression, only tobacco use remained associated with marijuana use (adjusted odds ratio 3.3, 95% confidence interval 1.9–5.9). Birth outcomes were available for 170 (43%) patients. Only three (1.9%) had positive toxicology screens at the time of delivery. Marijuana use was not related to late initiation of prenatal care (25.2% compared with 34.7%, P=.065), preterm deliveries (17.7% compared with 12.0%, P=.325), birth weight (3,025.6 g compared with 3,088.8 g, P=.555), or neonatal intensive care unit admissions (25.5% compared with 15.8%, P=.139). CONCLUSIONS: Cigarette smoking has the highest correlation to marijuana use in pregnancy. No differences were found in birth outcomes in this cohort.

Breast self-awareness: the evidence behind the euphemism.

Breast cancer is the most common malignancy among women. Breast self-examination originally was proposed and implemented under the assumption that it would increase early detection and, theoretically, improve survival. However, breast self-examination since has been proven to have no effect on mortality from breast cancer. Rather than being abandoned, breast self-examination has been repackaged into the new concept of breast self-awareness. Although the desire to empower women with self-detection of cancer is noble, teaching techniques that have been proven not to be effective likely causes more harm than good.

Risk of complication during surgical abortion in obese women

Background Surgical abortion is a generally safe procedure. Obesity is a known risk factor for complications in other surgical procedures, but insufficient information exists to determine the effects of increasing body mass index on the risk of surgical abortions. Objective The purpose of this study was to determine whether obesity is a risk factor for major complications in surgical abortions. Methods A quality control database from a single outpatient center was analyzed to determine rates of major complications during surgical abortions in relation to obesity class. Complications included hemorrhage, need for repeat evacuation, uterine perforation, cervical laceration, medication reaction, unexpected surgery, or unplanned admission to the hospital. Chi‐squared and analysis of variance were used for analysis. Results We included 2468 procedures: 1475 procedures (59.8%) in the first trimester and 993 procedures (40.2%) in the second trimester. The overall complications rate was 2.2%. Second‐trimester procedures were more likely than those in the first trimester to have complications (3.1% vs 1.6%; P=.009). Overall, 39.6% of the women were obese, and 9.6% of them met criteria for class 3 obesity (body mass index, >40 kg/m2). Women who underwent second‐trimester abortions with class 3 obesity had a rate of complication of 8.7%, which was significantly more than normal weight women (odds ratio, 5.90; 95% confidence interval, 1.93–8.07; P<.001). Comment Surgical abortions are overall safe procedures, but class 3 obesity increases the rate of complication in second‐trimester procedures.

Primary Placement of Incisional Negative Pressure Wound Therapy at Time of Laparotomy for Gynecologic Malignancies.

Objective Wound complications are an important cause of postoperative morbidity amongst patient with gynecologic malignancies. We evaluated whether the placement of prophylactic negative pressure wound therapy (NPWT) at the time of laparotomy for gynecologic cancer surgery reduces wound complication rates. Methods A retrospective analysis of patients undergoing laparotomy with primary wound closure performed by a gynecologic oncologist at a single academic institution over a 5-year study period was performed. Patients who had placement of prophylactic NPWT dressing were compared with patients with a standard closure. Postoperative outcomes were examined. Results A total of 230 patients were identified: 208 women received standard wound care, 22 received NPWT. Groups were similar in age, prevalence of diabetes, tobacco use, and number of previous abdominal procedures. Intraoperative factors including length of procedure and transfusion requirements were similar. Body mass index for patients receiving standard treatment was 30.67 compared with 41.29 for NPWT group (P < 0.001). Incidence of all wound complications was 19.7% for those receiving standard treatment versus 27.3% for NPWT group (P = 0.40). Length of hospital stay was similar between the 2 groups (5.25 vs 6.22 days, P = 0.20). There were 3 hospital readmissions for wound complications—none occurred in women with a prophylactic NPWT dressing. Conclusions Despite significantly higher obesity rates, patients with prophylactic NPWT dressing placement had similar rates of wound complications. Our findings suggest a potential therapeutic benefit in the use of prophylactic NPWT for the reduction of wound complications in this high-risk gynecologic oncology patient population.

Cigarette Smoking Status and Substance Use in Pregnancy

Objectives Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. Methods In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine. Participants were divided into three groups based on survey responses: nonsmokers, recent quitters (smoked in the month prior to pregnancy but not past month) and current smokers (past-month). Results Approximately 29% of participants reported smoking in the month before pregnancy. During pregnancy, 17, 12 and 71% were current smokers, recent quitters and nonsmokers respectively. Overall prevalence of illicit or prescription drug use in pregnancy was 27%. Cannabis was the most common drug used in pregnancy with prevalence of 22%, followed by opioids (4%), cocaine (1%), tricyclic antidepressants (TCAs) (1%), amphetamines (1%), and benzodiazepines (1%). On multivariable logistic regression, smoking in pregnancy was associated with a positive urine drug screen; with adjusted odds ratio (aOR) 4.7 (95% CI 2.6–8.3) for current smokers and 1.6 (95% CI 0.8–3.3) for recent quitters. Factors negatively associated with positive drug screen were second and third trimester pregnancies, 0.5 (0.3–0.9) and 0.3 (0.2–0.6) respectively; and employment, 0.5 (0.3–0.8). Conclusions for Practice Co-use of tobacco and illicit drugs, particularly cannabis, is relatively high during pregnancy. Additional research is needed to understand the health implications of co-use versus use of tobacco only. Given the strong association between smoking and other drug use, clinicians should routinely assess for illicit drug use in women who smoke during pregnancy.

Should prenatal care providers offer pregnancy options counseling

BackgroundProfessional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider.MethodsAt four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses.ResultsAt entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p < 0.001) and interested in options counseling (RRR = 5.48, p < 0.001) than those who were food secure. Most women were open to discussing with their provider if their pregnancy was planned (88%) or if they had considered abortion (81%). More than 95% stated they would be honest with their provider if asked about these topics.ConclusionsMost women are certain of their decision to continue their pregnancy at the initiation of prenatal care. However, there is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these women and ensuring unbiased, non-directive counseling on all pregnancy options.